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Contractor Section: <br />r ���.��-' d��- <br />t�l'��'sec�:'� `� �_. �_ <br />Vendor Name I Busine�s Name I UBI Number <br />�1"J_r_-�.�_.�Z� 4;-l'vJ� �-- <br />Stale of Washington Conlractor License Number. <br />�-ec�+— — _ - -- •— . <br />Vendorilailing Address City Slate ZiP <br />— /� <br />Phone Email <br />I, the Vendor, a�ree to receive the Backwater Prevention Device rebate check direcBy for the <br />installation at the a6ove referenced property address. By agreeing to receive the rebate check <br />directly, I agree lo Ihe foliowing: <br />�. The Back�ti�ater Prevention Device rebate amount will be deducted from ihe 5nai invoice <br />given to the property ou•ner for lho installation at lhe prope�ty address referenced above, if <br />the total ccst of the installation is greater than the rebale. <br />2. I, the Vendor, am a Washington State licensed contraclor. <br />3. The Ciry oi Evereri will send a Federal Form 1099 MISC to me, Ihe Vendor, for Backwater <br />R,venlion Device rebale payments lotaling more than 5600 per calendar year, 2nd will <br />report the same payments to the Internal Revenue Service. <br />I accept lhe payment of the Backwater Prevention Device rebale from the Ciry ot Everett pendiny <br />approval of the compfeted Backvaater Prevention Dewce rebate package by the City of E��erett <br />,F� ��� _ , �`t��_L.I�- <br />� � �` ❑a�o <br />SignaWre oi Contra�tor <br />